1. Grading Strength of Evidence Interactive Quiz Prepared for: The Agency for Healthcare Research and Quality (AHRQ) Training Modules for Systematic Reviews Methods Guide www.ahrq.gov

2. Is grading the strength of evidence the same as rating the quality of studies? A.Yes, they are the same thing. B.No, but you can grade strength of evidence at the same time that you rate the quality of the individual studies. C.No, you can grade the strength of evidence only after you have rated the quality of individual studies. Strength of Evidence Versus Quality

3. Strength-of-evidence grading specifies required domains. What are they? A.Risk of bias, consistency, directness, and precision B.Risk of bias, consistency, directness, precision, and publication bias C.Risk of bias, precision, strength of association, and directness Required Domains

4. Which list below reflects the correct grades for strength of evidence? A.High, moderate, low, very low B.Very high, high, moderate, low, very low C.High, moderate, low, insufficient Strength-of –Evidence Grades

5. What discretionary domains can be used to reach a strength-of-evidence grade? A.Dose-response association, plausible confounders, strength of association, and publication bias B.Plausible confounders, strength of association, applicability, funding sources, and publication bias C.Numbers of studies or articles, publication bias, and applicability Discretionary Domains

6. In combining scores for domains into an overall grade for strength of evidence, which of the following approaches can be used? A.Only the GRADE algorithm for weighting domains B.Only the reviewer’s own numerical weighting system C.Only the reviewer’s own qualitative (nonnumerical) approach D.Any of the above Combining Scores for Overall Grade

7. In scoring required and additional domains and in arriving at an overall grade for strength of evidence, which of the following should be done? A.Use only one senior reviewer to perform these tasks and report this score. B.Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report all scores. C.Use two or more reviewers, resolve differences by consensus or adjudication by a third party, and report a consensus score. Consensus Scoring

8.  To grade strength of evidence within a comparative effectiveness review, reviewers must:  Understand the major concepts of strength-of-evidence grading  Know the difference between rating the quality of individual studies and grading whole bodies of evidence  Know the four required domains to be assessed and the possible other domains that can be used  Understand the strength-of-evidence grades and the approaches that can be used to combine domain scores Summary

9.  This quiz was prepared by Kathleen N. Lohr, Ph.D., a Distinguished Fellow at RTI International.  This module is based on an update of chapter 11 in version 1.0 of the Methods Guide for Comparative Effectiveness Reviews (updated chapter available at: http://effectivehealthcare.ahrq.gov/ehc/produc ts/60/318/2009_0805_ grading.pdf ). Author